Students’ reflections on the introduction of virtual microscopy into general pathology training.

1. 1 Students’ reflections on the introduction of virtual microscopy into general pathology training. Diana Jonas-Dwyer*,Fay Sudweeks,Philip K. Nicholls &Tanya McGill *Medical Education (Managed Learning Systems) Education Centre, University of Western Australia

2. Who learns histology & pathology? Year 1 Basic Histology Veterinary Chiropractic Year 2 Further Histology Animal Science Biomedical Sci. Year 3 General Pathology Year 4 Systemic pathology Year 4 Other units Year 5 Post-mortem & biopsy clinical rotations Year 5 Other units & clinical practicum

3. Teaching media N=370 Lectures (mixed cohorts, with cohort-specific lectures where applicable) Resources: texts, internet

4. Teaching media Powerpoint self-paced tutorials (delivered via WebCT)

5. Teaching media Laboratory workshops

8. Our concerns • Do some students find working a light microscope a technical barrier to learning? • Do all cohorts need to learn technical skills in light microscopy? • Do some students take only a passive role on the multiheader microscopes? • Limited time for private study and revision in the multiheader microscope suite • Can we make it better?

9. Our study • Introduction of a virtual microscope in laboratory classes • Random allocation to either optical or virtual microscope group for labs • Complete ASSIST at the beginning of semester and again at the end.

10. Our study • ASSIST • Entwistle’s Approaches and Study Skills Inventory for students ASSIST (1998) to identify deep, surface and strategic learners • Lectures, Labs, virtual microscope, blended environment (eLearning: images and questions) • Gather both qualitative and quantitative data (Log book (lab time), eLearning tracking – use of resources (images and formative assessments). • Longitudinal case study

11. Implementation computer labs Choose good examples from class slide set wireless network Aperio slide scanning n.b. pairs RCPA QAP Pty Ltd Anatomical Pathology - VIC

12. Aperio screenshot

13. Optical microscopy +ve nothing particular gaining experience superior slide quality more sense of control enhanced clarity more teacher interaction familiarity authenticity better group work promotes group discussions

14. Optical microscopy +ve • “The group atmosphere was probably the highlight of the optical microscopes” • “… at higher magnification it was a lot clearer to view slides in comparison to virtual” • “You get to see everything for real and you get experience using a microscope” • “Can look at slide with naked eye view first, it made things seem very real, a computer cannot replicate that” • “Give a realistic and relevant element to learning (i.e. its real tissue), Gets you to learn how to use a microscope and the problems you have with it. It not just another simulation”

15. Optical microscopy -ve 3% 5% 8% 40% 15% 30% 35% dislike everything needs experience missing slides health issues time consuming not in control difficult to use

16. Optical microscopy -ve • “They gave me constant headaches and sore eyes” • “In addition, using the microscope gave me motion sickness when other people were operating it” • “Can be a bit complicated to operate because of all the parameters that can be adjusted.” • “The time spent looking for slides that had not been put back into the correct box” • “Sometimes you want to look at something a bit longer or sketch something, but you don’t want to have to make the group wait”

17. Virtual microscopy +ve more examples of pathology easier to work in groups 3% more convenient 3% 10% fewer health problems 13% more examples 65% 15% freedom & accessibililty better time management 20% handy tools (photo, measure, side by side, naked eye navigator,) 23% easy to use 63%

18. Virtual microscopy +ve • “Ease of use, don't need to know how to use a microscope and since I'll never have to use one in my career that is ideal for me” • “It is so much easier to use than optical. You can change the magnification quickly and easily. You can zoom into the exact area you want" • “You can take photos of it and email to yourself (you can take it home virtually)” • “...it was available on a variety of computers, which made it very accessible” • “It would have been nice to access it from home” • “Probably the best part is that all the slides are there to use there is no need to sort through hundreds of glass slides to find the one you need” • “No headaches either”

19. Virtual microscopy -ve less authentic 5% less engagement 5% unreliable technology 5% 38% less group work 5% reduced clarity no dislikes 10% restricted access 13% 13% waiting for slide upload

20. Virtual microscopy -ve • “Images at higher magnifications are not as sharp and clear” • “Would be better if you could access the slides from home” • “Took too long to load up sometimes” • “There was also less group discussion involved as each student has an individual program” • “You feel more of a distance to what you are looking at when you can't "put hands" on it”

21. Our concerns • Do some students find working a light microscope a technical barrier to learning? • Do all cohorts need to learn technical skills in light microscopy? • Do some students take only a passive role on the multiheader microscopes? • Limited time for private study and revision in the multiheader microscope suite • Can we make it better?

22. Improvements • Deliver via DVD as well as network (home study) • Encourage students to work in groups • Description games • Alter laboratory layout for better group work • Assigning a slide to a group for annotation & presentation to rest of class via data projector • Alternate between virtual & optical groups • Use virtual slides for take home exam (description & diagnosis) • Use annotation files to answer queries via online learning systems (WebCT/CE6) • Align assessment with objectives and activities (examine via structured image-based questions)

23. Acknowledgements • The work presented here forms part of the PhD programme of Diana Jonas-Dwyer, Medical Education (Managed Learning System) Education Centre, University of Western Australia.

24. IT skills Students’ self-rating of IT skills

25. 4 H&E x100

26. Sheep heart x 10 • Slide 110A. Heart, left ventricle, sheep • Bundle of Purkinje fibres within left ventricular myocardium Zoom in! what’s this? You should be able to compare and contrast features of three muscle types. One feature unique to cardiac muscle is seen here. What is the feature shown? Note the pale and enlarged cytoplasm of these specialised cells. What is the name, and function, of these cells, unique to myocardium? Purkinje fibres – specialised for electrical conduction.

27. IC disk IC disk IC disk Zoom in! striations You should be able to see cross striations in heart in LS, but don’t confuse them with intercalated disks.